Provider Demographics
NPI:1073982955
Name:MYERS, HOLLY (PT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5165 ADANSON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1331
Mailing Address - Country:US
Mailing Address - Phone:407-303-9603
Mailing Address - Fax:407-303-8031
Practice Address - Street 1:711 E ALTAMONTE DR
Practice Address - Street 2:STE. 200
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4806
Practice Address - Country:US
Practice Address - Phone:407-303-5465
Practice Address - Fax:407-303-5467
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist